What tests and assessments should be performed during a Medicare annual wellness visit?

Medicare Annual Wellness Visit Components

The Medicare Annual Wellness Visit should include a comprehensive health risk assessment, physical measurements, cognitive screening, depression screening, functional assessment, preventive screenings, and personalized prevention planning to identify and address health risks early. 1

Core Medical Assessment Components

• Complete medical history review including family history of autoimmune disorders, complications, and common comorbidities such as obesity, obstructive sleep apnea, and non-alcoholic fatty liver disease 2, 1
• Medication review including assessment of medication-taking behavior, potential rationing of medications, medication intolerance, and side effects 2, 1
• Physical measurements including height, weight, BMI calculation, and blood pressure determination 2, 1
• Cognitive assessment using validated screening tools such as the Mini-Cog Test, Memory Impairment Screen, or General Practitioner Assessment of Cognition 2, 1, 3
• Depression screening using validated tools such as the Patient Health Questionnaire-2 (PHQ-2) or Patient Health Questionnaire-9 (PHQ-9) 1, 4
• Functional assessment to evaluate activities of daily living and mobility, particularly important for patients 65 years and older 1, 5

Laboratory Tests and Screenings

• Complete blood count (CBC) with differential to screen for anemia, infection, and blood disorders 6
• Comprehensive metabolic panel (CMP) to assess kidney function, liver function, and electrolyte balance 6
• Lipid profile including total, LDL, and HDL cholesterol and triglycerides if not performed within the past year 2, 6
• Hemoglobin A1C testing if not available within the past 3 months, especially for those with BMI ≥25 kg/m² with additional risk factors 2, 6
• Urinalysis with albumin-to-creatinine ratio to screen for kidney disease 2, 6
• Vitamin B12 levels for patients on metformin 2

Cancer Screenings

• Colorectal cancer screening beginning at age 45 with one of the following options: annual fecal immunochemical test (FIT), colonoscopy every 10 years, CT colonography every 5 years, or flexible sigmoidoscopy every 5 years 6
• For women: Clinical breast examination and mammography screening biennially for women aged 50-74 years 1
• For women: Cervical cancer screening with cervical cytology (Pap smear) every 3 years, or for women aged 30-65 years, screening with a combination of cytology and HPV testing every 5 years 1
• For men: Discussion of prostate cancer screening options, with PSA testing and digital rectal examination offered annually beginning at age 50 for average risk men, or at age 45 for high-risk men (African American men or those with family history) 6

Immunization Assessment

• Review of vaccination history and needs, including influenza, pneumococcal, tetanus-diphtheria-pertussis, COVID-19, and other age-appropriate vaccines 2
• Influenza vaccination is particularly important for older adults and those with chronic conditions like diabetes, as it significantly reduces hospital admissions and mortality 2

Social and Behavioral Assessment

• Social determinants of health assessment including food security, housing stability, transportation access, financial security, and community safety 2, 1
• Tobacco, alcohol, and substance use screening with appropriate counseling 2, 1
• Physical activity and sleep behaviors assessment, including screening for obstructive sleep apnea 2, 1
• Eating patterns and weight history review 2, 1

Personalized Prevention Planning

• Development of a personalized prevention plan based on identified risk factors and health needs 1, 4
• Referrals to health education and prevention counseling services as needed based on screening results 1, 4
• Advance care planning discussions including identifying surrogate decision makers 2, 4

Common Pitfalls to Avoid

• Substituting brief physical examinations for the comprehensive preventive services required by Medicare 1, 5
• Neglecting mental health screening, which is a critical component of the wellness visit 2, 1
• Focusing solely on physical health while neglecting behavioral and social aspects of health 1, 5
• Failing to repeat abnormal test results for confirmation before making a diagnosis 6
• Delaying colorectal cancer screening beyond age 45, as guidelines have recently lowered the recommended starting age from 50 to 45 6

Implementation Considerations

• The Medicare Annual Wellness Visit can be effectively delivered by various healthcare providers, including pharmacists, which can improve practice efficiency 7, 4
• Using electronic health record-based tools combined with practice redesign approaches can significantly increase AWV utilization and completion of preventive services 4
• Standardized assessment tools can improve the consistency and quality of AWVs 5